Quantitative Magnetic Resonance Imaging in Perianal Crohn's Disease at 1.5 and 3.0 T: A Feasibility Study

Perianal Crohn's Disease (pCD) is a common manifestation of Crohn's Disease. Absence of reliable disease measures makes disease monitoring unreliable. Qualitative MRI has been increasingly used for diagnosing and monitoring pCD and has shown potential for assessing response to treatment. Quantitative MRI sequences, such as diffusion-weighted imaging (DWI), dynamic contrast enhancement (DCE) and magnetisation transfer (MT), along with T2 relaxometry, offer opportunities to improve diagnostic capability. Quantitative MRI sequences (DWI, DCE, MT and T2) were used in a cohort of 25 pCD patients before and 12 weeks after biological therapy at two different field strengths (1.5 and 3 T). Disease activity was measured with the Perianal Crohn's Disease Activity index (PDAI) and serum C-reactive protein (CRP). Diseased tissue areas on MRI were defined by a radiologist. A baseline model to predict outcome at 12 weeks was developed. No differences were seen in the quantitative MR measured in the diseased tissue regions from baseline to 12 weeks; however, PDAI and CRP decreased. Baseline PDAI, CRP, T2 relaxometry and surgical history were found to have a moderate ability to predict response after 12 weeks of biological treatment. Validation in larger cohorts with MRI and clinical measures are needed in order to further develop the model.

Midbrain venous angioma with obstructive hydrocephalus

A rare case of a mid brain venous angioma with obstructive hydrocephalus is described. A dilated draining vein from the lesion in the aqueduct as the cause of the hydrocephalus is highlighted, and interesting features of the pathology of venous angiomas and associated cavernous hemangioma are described. The management of this interesting condition is discussed.

Monitoring of facial evoked EMG for hemifacial spasm: a critical analysis of its prognostic value

Microvascular decompression (MVD) has come to stay as an effective way of treating hemifacial spasm. But it remains to be seen how much each of the electrophysiological monitoring techniques (intra-operative) are contributing to its increased efficacy. Their role as indicators for re-exploration or recurrence is to be evaluated with more studies. We have used the lateral spread response in those patients who had distinctly abnormal recording on the ipsilateral side, studied the intra-operative changes during MVD and correlated with the outcome of surgery. 38 patients operated for HFS, were selected for intra-operative monitoring of abnormal muscle responses. In 17 patients, there was persistence of abnormal muscle responses in the immediate postoperative period and only 6 of them had mild HFS. Two of 21 patients who had disappearance of abnormal responses had persistent mild HFS; but in all cases, the HFS disappeared within 3 months. So we found that the intra-operative recording was really not reliable in predicting the immediate postoperative outcome. However the outcome at 3 months suggested that waiting for some time before re-exploration is a better option, especially if the HFS had become mild.

Cisternal cysticercosis: a diagnostic problem--a short report

We describe a patient in whom a hypodense nonenhancing mass on CT scan in the regions of quadrigeminal cistern, and causing obstructive hydrocephalus, was initially diagnosed as an epidermoid but subsequent MR evaluation and surgery resulted in the diagnosis of a racemose cysticercus cyst.

Strategy for the treatment of arteriovenous malformations

The treatment of arteriovenous malformations (AVMs) is still a challenging problem in the neurosurgical field. The deep-seated AVMs are a definite indication for radiosurgery for the small AVMs and with pre-embolisation for the large AVMs. The superficial AVMs are a good indication for surgery. In the case of small AVMs, surgery alone is a viable option; however, in the case of large AVMs, pre-operative embolisation is essential for prevention of NPPB (normal perfusion pressure breakthrough). Embolisation alone cannot be used, except for a small AVM in the non-eloquent cortex. Preoperative embolisation makes surgery easy; however, it causes the surrounding cortex to infarct. Hyperperfusion may occur after the direct removal of high-flow large AVMs, therefore postoperative management will be difficult in these cases. In eloquent cortex minimally invasive surgery is more reliable with respect to the morbidity produced. Therefore in cases of small AVMs in the functional cortex, direct surgery is the only choice. In cases of high-flow large AVMs, surgery and postoperative management are risky because of NPPB. Therefore pre-operative embolisation followed by surgery is a better choice. In high-flow AVMs, local blood circulation is not decreased by temporary clipping of the feeding arteries. So we recommend temporary clipping of all feeding arteries, even away from the nidus where it is easier to control bleeding.

Neurosurgery at Fujita Health University, Japan

Neurosurgery at the Fujita Health University began in 1972 with Dr. Tetsuo Kanno. In 1973, he was joined by Dr. Kazuhiro Katada and in the year 1976, an independent neurosurgery department was established with Dr. Kanno as the Chief of Neurosurgery. Under his guidance the department continued to grow and by 1978, a neurosurgical residency program recognised by the Japanese Board of Neurosurgery was established. Integration of laboratory research and clinical experience is the hallmark of this program. The current philosophy is directed towards subspecialization and academic training. This article provides a brief overview of the rapid development of a Neurosurgical Centre to reach international acclaim under the guidance of Prof. Tetsuo Kanno.

Post operative supplementary motor area syndrome: clinical features and outcome

The syndrome of the supplementary motor area (SMA) is not well recognized and its features can easily be confused with pyramidal weakness. The authors describe the SMA syndrome in six patients who underwent surgery for tumours located in the SMA, three in the dominant and three in the non-dominant hemispheres. All of them underwent complete resection of the anatomically described SMA, with partial (n = 4) or total resection (n = 2) of the tumour. In the postoperative period, all these patients exhibited reduction of spontaneous movements and difficulty in performing voluntary motor acts to command in the contralateral limbs, although the tone in the limbs was maintained or increased. The function of these limbs in serial automatic motor activities (for example, dressing and walking) was, however, relatively unaffected. Speech deficits were seen in only one of three patients with the dominant SMA syndrome. Besides a severe impairment of volitional movements, the salient features of the deficits in this syndrome are hemineglect and dyspraxia or apraxia involving the contralateral limbs. All patients recovered their motor functions over varying periods of time ranging from one to a few weeks. Long-term follow-up (median 24 months) in five patients revealed complete return of function in the affected limbs. It is important to recognize the entity of the SMA syndrome and differentiate it from the deficits that result from operative damage to the motor cortex as the deficits associated with the former are likely to recover almost completely over a short period of time.

Cysticercosis of the cerebellopontine angle cistern mimicking epidermoid inclusion cyst

We report a case of a cystic lesion in the left cerebellopontine (CP) angle cistern. The magnetic resonance (MR) imaging features closely resembled an epidermoid inclusion cyst, and was interpreted as such. However, at surgery and on histopathological examination the lesion was found to be a cysticercus cyst. It may be impossible to distinguish between the two by imaging. The MR imaging findings of cysticercosis, epidermoid and other common differentials are discussed.

Stereotactic catheter placement in the management of cystic intrcranial lesions : indications and results

Stereotactic techniques were used to place a catheter into cystic intracranial lesions in 11 patients. These patients had 4 types of cystic lesions : suprasellar craniopharyngiomas (4), benign epithelial cysts (2), suprasellar arachnoid cysts (3) and tumour cysts (2). Seven patients had subgaleal reservoir placement and four had cystoperitoneal shunt. There was no procedure related morbidity. In all the patients, a post procedure CT scan revealed accurate placement of the catheter. The mean follow-up period was 23 months. During this period, 3 of the 7 patients with reservoir placement had become symptomatic and had to undergo a percutaneous aspiration of the cyst through the subgaleal reservoir. One patient required repositioning of a displaced catheter, and one patient received bleomycin through the reservoir after aspiration of the craniopharyngioma cyst. Eight patients improved and are leading independent lives. Stereotactic catheter placement is a minimally invasive, safe, accurate and simple procedure which can be used in the management of selected cystic masses in the brain. Connection of the catheter to a reservoir or a shunt ensures access to the cyst in case of reaccumulation of its contents and provides continuous drainage of its contents.

High cervical intraspinal enterogenous cyst

A case of histologically verified ventro-laterally placed enterogenous cyst in the upper cervical region is reported.